Provider Demographics
NPI:1053644724
Name:HILLSIDE FAMILY HEALTH CLINIC PA
Entity type:Organization
Organization Name:HILLSIDE FAMILY HEALTH CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:806-373-4010
Mailing Address - Street 1:7130 BELL ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7003
Mailing Address - Country:US
Mailing Address - Phone:806-373-4010
Mailing Address - Fax:
Practice Address - Street 1:7130 BELL STREET
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-373-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0231599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty